TOMAS CHEN
Dependent on policy B02M000325
Claims
3
Attributed to this person
Charged
2,034.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
40.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | TOMAS CHEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000325 |
| Date of birth | 4 Jan 2004 |
| Plan | BRONZE EPO |
| Covered from | 8 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001392 | 16 Mar 2026 | 611.00 | CASCADE CARE | Not denied | — |
| CLM0001393 | 30 Oct 2025 | 560.00 | CASCADE CARE | Not denied | — |
| CLM0001391 | 9 Dec 2024 | 863.00 | CASCADE CARE | Not denied | — |